Effectiveness of Unilateral and Bilateral Type I Thyroplasty for Nonparalytic Vocal Fold Atrophy

Vocal fold atrophy is a common cause of dysphonia, particularly in older adults, and is characterized by glottic insufficiency and impaired voice quality. Although type I thyroplasty is an established surgical intervention, its comprehensive effects on voice outcomes remain unclear. This study systematically evaluated the therapeutic outcomes of unilateral and bilateral type I thyroplasty using Gore-Tex for non-paralytic vocal fold atrophy using aerodynamic measurements, patient-reported assessments, auditory-perceptual evaluations, and acoustic analyses, aiming to clarify both the strengths and limitations of the procedure.

Eleven patients who underwent type I thyroplasty for vocal fold atrophy between April 2018 and March 2025 were included. Surgery was generally performed bilaterally during the same session. However, intraoperative voice monitoring was conducted, and if the patient was sufficiently satisfied with the voice outcome, the procedure was concluded after unilateral medialization. Voice outcomes were assessed preoperatively and at 1 month and 1 year postoperatively using maximum phonation time (MPT); Voice Handicap Index (VHI)-30; the grade, roughness, and breathiness components of the GRBAS scale; jitter; and shimmer. The primary endpoint was the 1-year postoperative assessment. All outcome measures were analyzed using the Wilcoxon signed-rank test, with P<0.05 considered statistically significant.

At 1 year postoperatively, MPT significantly improved compared with preoperative values (P<0.05). VHI-30 and the grade, roughness, and breathiness components of the GRBAS scale also showed significant improvement (P<0.05). In contrast, jitter and shimmer did not show significant postoperative changes.

Type I thyroplasty for non-paralytic vocal fold atrophy significantly improves MPT, VHI-30, and GRBAS scores, indicating enhanced phonatory function. However, improvements in acoustic parameters, such as jitter and shimmer, appear limited. These results underscore the procedure's value in clinical practice and the need to tailor treatment and set realistic expectations for each patient's voice outcomes.